II. Pathophysiology
- Air continues to accumulate in pleural space, but cannot escape
III. Symptoms
- Sudden sharp Chest Pain
- Air Hunger
IV. Signs
- Unilateral absent breath sounds
- Hyperresonant chest to percussion
- Cyanosis
- Respiratory distress
- Tachycardia
- Hypotension
- Tracheal deviation to contralateral side
- Neck vein distention
V. Imaging
- Bedside Ultrasound
-
Chest XRay
- Do not use XRay to diagnose a Tension Pneumothorax
- Confirm diagnosis by Chest XRay after decompression
VI. Differential Diagnosis
VII. Precautions
- Tension Pneumothorax is a clinical diagnosis (not an imaging diagnosis)
- Do not obtain a Chest XRay prior to needle decompression (delays are lethal)
- Needle decompression buys a small amount of time in which to place a Chest Tube for definitive management
VIII. Management
- Emergent Needle Thoracentesis
- Do not wait for Chest XRay
- Use 14 gauge (5 cm long) angiocatheter in children and 10 gauge (7.5 cm long) angiocatheter in adults
- Insert angiocatheter over the top of the third rib in the mid-clavicular line
-
Chest Tube
- Perform immediately after needle decompression
- Insert over the top of the 5th rib in the mid-axillary line